Cancer Centre of Southeastern Ontario, 25 King Street West, Kingston, ON K7L 5P9, Canada.
Program in Evidence-Based Care, Department of Oncology, Juravinski Campus, McMaster University, 711 Concession Street, Hamilton, ON L8V 1C3, Canada.
Curr Oncol. 2023 Jul 8;30(7):6575-6586. doi: 10.3390/curroncol30070482.
Pancreatic cancer is the seventh leading cause of cancer deaths worldwide, accounting for 4.7% of all cancer deaths, and is expected to climb significantly over the next decade. The purpose of this systematic review and guidance document was to synthesize the evidence surrounding the role of adjuvant treatment (chemotherapy and chemoradiation therapy [CRT], and stereotactic body radiation therapy [SBRT]) in resected pancreatic ductal adenocarcinoma (PDAC). Systematic literature searches of MEDLINE, EMBASE, and 11 guideline databases were conducted. Both direct and indirect comparisons indicate adjuvant chemotherapy offers a survival advantage over surgery alone. The optimal regimens recommended are mFOLFIRINOX with alternative options of gemcitabine plus capecitabine, gemcitabine alone, or S-1 (which is not available in North America). Trials comparing a CRT strategy to modern chemotherapy regimens are lacking. However, current evidence demonstrates that the addition of CRT to chemotherapy does not result in a survival advantage over chemotherapy alone and is therefore not recommended. Trials evaluating SBRT in PDAC are also lacking. SBRT should only be used within a clinical trial or multi-institutional registry.
胰腺癌是全球第七大癌症死因，占所有癌症死亡人数的 4.7%，预计在未来十年内将显著上升。本系统评价和指南文件的目的是综合评估辅助治疗（化疗和放化疗[CRT]以及立体定向体放射治疗[SBRT]）在切除的胰腺导管腺癌（PDAC）中的作用。对 MEDLINE、EMBASE 和 11 个指南数据库进行了系统文献检索。直接和间接比较均表明辅助化疗比单独手术具有生存优势。推荐的最佳方案是 mFOLFIRINOX，替代方案是吉西他滨加卡培他滨、吉西他滨单药或 S-1（北美不可用）。比较 CRT 策略与现代化疗方案的试验缺乏。然而，目前的证据表明，与单独化疗相比，CRT 联合化疗并不能带来生存优势，因此不推荐使用。评估 SBRT 在 PDAC 中的试验也缺乏。SBRT 只能在临床试验或多机构登记处使用。
